Published March 23, 2018

Are you ready?

As of November 15, 2017, your facility was required to have an Emergency Preparedness program. This CMS mandate required facilities to develop a “comprehensive approach to meeting the health, safety and security needs of their staff and patient population during an emergency or disaster situation. The program must also address how the facility would coordinate with other healthcare facilities, as well as the whole community during an emergency or disaster” (CMS §483.73). While we are finding that many facilities have this task crossed off their list, some are missing some critical plan details.

Keep in mind, your plan needs to include:

1. An “All-hazards” approach with facility AND community assessments. This may require meeting with community leaders, emergency services and the hospital you partner with. Additionally, a full-scale community-based drill is required annually including a facility drill or table top exercise.

2. Arrangements with other facilities and providers to receive or transfer residents during an emergency event. This includes tracking of staff and residents and a variety of transportation services such as taxi’s, ambulance companies, etc.

3. A comprehensive communication plan, incorporating state and local notifications along with staff and family notifications. This may include developing a method for obtaining and keeping contact information current and how to provide the information to staff and family’s.

4. Don’t forget to include your Memorandums of Understanding. These are such things as an agreement for potable water to be provided and facility agreements for accepting residents or transferring residents.

5. A policy and procedure for volunteers, current volunteers and those that may come from the community to assist in an emergency, that addresses their roles and on-boarding education.

6. A training program that includes annual training for employees, a full-scale community-based exercise, and a table-top exercise such as active shooter, missing resident, or a weather-related event.

Now is the time to ensure your plan is comprehensive and that it meets these new requirements. Many of our clients are reporting a high priority focus on their Emergency Preparedness plans by survey teams during recent surveys, some taking the better part of a day to review. You can access the requirements for Emergency Preparedness or feel free to contact us if you need assistance.

Donna Barron, RN, BA, CIC